EMS personnel are often intimidated when tasked with performing triage, particularly initial triage, at a scene. They worry that if they assign the wrong priority to a victim, a patient might not get the care they need soon enough or survive. The reality: Your early EMS training probably gave you most of the knowledge you need to perform triage correctly. Let me explain.
A “75/75″ Perspective
Of all the patients we see in EMS, I’d say that approximately 75% are BLS in nature. These patients have “minor” injuries and fit the definition of Priority 3 triage patients. They’re usually given a green tag, meaning treatment can be delayed. This is a group that you could place in a school bus with some EMS personnel, a kit and a radio, and transport to a more distant hospital from the scene of a mass-casualty incident (MCI).
We routinely classify the 25% who aren’t BLS as ALS patients. However, most of these aren’t critical and will probably do just fine with close monitoring, a KVO of sugar water (D5W), direct pressure and bandaging, immobilization and transportation. These patients fit the Priority 2 triage category. They’re given a yellow tag and need intermediate-level care. They aren’t critical, but they aren’t minor either. We’re concerned about them, treat them and closely monitor them.
Only a small percentage of ALS patients (about 25%) are what I refer to as “ALS prime”–patients who need immediate, intensive, constant care and have conditions and vital signs that, if left untreated, will result in death in probably 20 minutes or less. These patients, who should be given a red tag and leave an MCI scene before all others if at all possible.
If you don’t address and treat such conditions as arterial bleeds, uncontrolled hemorrhage, severe respiratory distress and respirations at a rate of less than 10, or greater than 30 per minute, the patients will rapidly deteriorate. Adult patients with pulses greater than 100 or in shock may get worse and have the potential to die if you don’t act quickly (see Table 1).
Experience has shown me it’s best to also assign red tags to a few “outlier” patients, including ill or injured victims in the following populations:
- Pregnant patients (because I believe “both” patients should be assessed at a hospital as soon as possible);
- Infants who cannot communicate, appear injured or in distress and are of concern to you;
- Emotionally uncontrollable victims who are riling up others on scene; and
- Emergency personnel (because it can cause emotional concern to their colleagues if injured or ill responders are left in a low-priority treatment area).
Don’t complicate triage. Consider it, for the most part, a simple extension of your daily BLS or ALS routine. “ALS primes” should be tagged red (Priority 1/Immediate). Those who are ALS but not critical should be tagged yellow (Priority 2/Secondary), and those with minor injuries should be tagged green (Priority 3/Delayed). JEMS
Red Tag–”ALS Prime”–High Priority
Open (penetrating wounds) from the throat to the crotch (those that may need surgical intervention)
Loss of consciousness
Severe or uncontrollable hemorrhage (or in shock)
Severe respiratory distress
Respiratory arrest (if you have the resources to manage them)
Burns affecting the face and/or respiratory system
Complicated fractures (e.g., femur fractures; severe, open fractures; fractures with associated loss of pulse)
Pregnancy (with obvious illness or injury, or exhibiting symptoms)
Yellow Tag–”Monitor Closely”–Intermediate Priority
Moderate blood loss (not life-threatening)
Burns not affecting the face or respiratory system
Head or spinal injury (conscious and with no dyspnea)
Green Tag–”Low Priority/Minor Injury”–Delayed Priority
Walking wounded (need BLS care only)
Minor injuries (controllable)
Potentially mortal wounds or conditions (may be able to get or free up resources to manage)
Black Tag–”Dead Already/Beyond Any Hope”
Obviously dead (or resources aren’t available, and you aren’t going to be able to care for them)
This article originally appeared in May 2011 JEMS as “Triage Is Easy: Sorting patients should be an extension of daily practice”.